Provider Demographics
NPI:1235382797
Name:ROMAN, GLADYS NEIDA (LCSW)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:NEIDA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 ALDERTON ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5001
Mailing Address - Country:US
Mailing Address - Phone:718-896-7111
Mailing Address - Fax:718-896-7111
Practice Address - Street 1:6515 ALDERTON ST APT 4F
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5001
Practice Address - Country:US
Practice Address - Phone:718-896-7111
Practice Address - Fax:718-896-7111
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0473081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical